Bruxism is a masticatory automatism that manifests itself by clenching or rubbing the teeth with sudden, strong and repeated movements, especially at night, but it can also be present during the day, both conscious and unconscious.
Good bruxism can occur in children after rash of milk teeth, or sometime after rash. In this case, bruxism has the physiological role of balancing and harmonising the structures that make up the dental-masticator system.
Bruxism is considered physiological as long as there are no unpleasant signs and symptoms and the body is using it as a kind of energy valve when there is an accumulation of tension and stress.
Bruxism is considered a parafunction when signs and symptoms indicate this.
- frequent headache, pain in the the ear area and on the temporal mandibular joint
- fatigue of masticatory muscles especially in the morning
- clenched mouth
- gnashing teeth night / day
- sensitive teeth
- the over-developed masseter muscles
- abnormal dental wear (abrasion, erosion, enamel cracks, dentine exposure, dental fractures, pulp inflammation, pulp necrosis)
- widening of periodontal space, gingival inflammation, advanced periodontal disease, dental mobility, loss of teeth
Clinically, in the early stages of the disease, we notice the "grinding" of the teeth by increasing the translucency of the enamel, due to its thinning. Then, as the disease progresses, at the patients who have neglected this bruxism for long periods of time, the teeth become oblique to the gingival rebellum, the temporomandibular joint, the volume increase of the masseter muscle and the headaches.
The picture described above is valid if the patient has a strong periodontium and a weaker dental structure, so the teeth are ground. In the reversed case where the teeth are strong, it will give up the periodontitis and periodontal disease will occur which, untreated, will lead to the loss of teeth. In both cases, the joint sooner or later will be affected.
Bruxism (movement through the muscles) is an aggression on the teeth, periodontium and temporomandibular joints. Against this aggression, the weakest structure will fail.
These changes in the masticatory device become insidious and, for this reason, most patients do not realize they suffer from bruxism.
Causes of bruxism
There were no precise causes for this habit, but it was associated with several factors:
Stress, emotions, anger, tension, pain, frustration, anxiety, agitation, fear, outstanding events
Some drug treatments
Insufficient or poor quality rest
Aggressive, obsessive, perfectionist or anxious people have a high chance of developing bruxism.
Dental incongruities or dental eruption
Changing temporary to permanent dentition
Disproportionate development of jaw bone
Recent obturations or recent prosthetic works that are improperly adapted occlusively.
Establishing the treatment plan for bruxism is done taking into account the potential source of the problem. Depending on the degree of dental wear and potential cause, the dentist may recommend:
Using a night guard during the night. The device is custom made of a plastic that is moulded on the patient's teeth and covers the teeth to prevent them from scratching. This night guard is recommended in non complicated cases, where there are no signs of aggression, or in cases of large rehabilitation when ceramic / crown works need to be protected.
Relaxation. Daily stress is an important cause of bruxism, so it is advisable to reduce stress by relaxing activities.
Rebalancing the occlusal relief to correct the bite.
The vast majority of cases of bruxism are associated with occlusal imbalances. That is, there are some dental-dental contacts that unbalance the mandible by making it have some eccentric tooth, periodontal, and articular movements. The teeth are the the ones that stabilise the mandible at the base of the skull, they have a role, we might say, orthopaedic. Knowing this and considering that the teeth act as a unitary one, any imbalance in their level, any extraction, any change in position, any alteration of the occlusal shape by seals or inappropriate prosthetic work leads to an imbalance in the position of the mandible against the skull. This imbalance will cause a tension in the mandibular positioning muscles, which will then determine their stress (the action-reaction principle) through strong, aggressive movements (bruxism).
The treatment always starts with a relaxation therapy and for this the patient will be given a night device like a classic night guard, but it will serve to disfigure dental dental contacts, allowing the muscles to relax. Once the relaxation has been achieved (it may take a few weeks to several months), the occlusal balancing is made, which, depending on the situation, is different. Thus, in simple cases selective grinding is done, and complex cases may require orthodontic treatment, obturation, dental crowns.
A bite is balanced when the teeth have uniform, functional contacts without damaging themselves or the structures in the neighbourhood, periodontium, muscles, joints.
For details of your treatment plan if you are a patient in the Unirii Clinic discuss with the following Key Patient Guides:
For details of your treatment plan if you are a patient in the Militari Clinic discuss with the following Key Patient Guides: